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If you’re a mom-to-be with your heart set on a natural delivery, the news that your baby needs (or may need) to be delivered by cesarean section can be incredibly disappointing. Visions of pushing baby out the way nature intended (and the way you’ve maybe always dreamed) can sometimes be rudely displaced by worries about the surgery, about being stuck in the hospital longer, and about the tougher recovery (not to mention the less-than-supermodelicious scar). But currently in the United States, about 33 percent of babies are delivered by cesarean — which means, all things being equal, you have about a one in three chance of having to go the C-section route. While it’s true that any surgery can be a scary proposition that should be taken seriously, with some mental and emotional preparation there's no need to despair if a C-section seems in the cards.

Your weight. Being obese significantly increases your chance of needing a C-section, partly because of the other risk factors that often accompany obesity (like gestational diabetes), and partly because obese women tend to have longer labors (which, in turn, ups your risk of ending up on the operating table).

Your age. While being older doesn’t guarantee a cesarean delivery, the odds of one increase with age.

Breech position. When your baby is either feet-first or butt-first a breech position and can't be turned, your practitioner might determine a C-section is necessary.

Multiples. The likelihood of the procedure increases with the number of babies you’re carrying.

Placental problems. If the placenta is partly or completely blocking the cervical opening (placenta previa) or has separated from the uterine wall (abruptio placenta), a C-section is likely safer for you and your baby.

Other complications. If you develop preeclampsia (pregnancy-induced high blood pressure) or eclampsia (a very rare progression of preeclampsia that affects the central nervous system, causing seizures) and treatment isn't working, your practitioner might opt for a cesarean to protect both of you.

If your practitioner says that a C-section is necessary — or likely necessary — ask for a detailed explanation of the reasons and if there are any alternatives open to you.

Reasons for an Unscheduled C-Section

Far more frequently, the need for a cesarean isn't obvious until a woman is well into labor. A few of the most common reasons:

Labor doesn’t start. If your labor just can't seem to get moving in the first place (your cervix isn't dilating although you're having contractions) — after 24 or 25 hours in a first-time mother (less if it is not your first delivery) — your doctor might decide on surgery.

Labor stalls. You might sail right through the early stage of labor (dilation to three centimeters), only to grind to a halt. While it's possible that oxytocin or another labor stimulator could jump-start the contractions, if the problem is that your baby's head is too big to fit through your pelvis (which is the case about half the time) a cesarean is necessary.

Exhaustion or fetal distress. If your doctor determines you’re becoming too exhausted, or if the fetal monitor is picking up signs of fetal distress, he or she may opt for a cesarean.

A prolapsed umbilical cord. If the umbilical cord slips into the birth canal in advance of the baby, it will be compressed as the baby comes through, cutting off his or her oxygen supply.

Uterine rupture. If your uterus tears, C-section is required.

Elective C-Sections

Thinking about requesting a planned C-section from your OBGYN? In 2013, the American Congress of Obstetricians and Gynecologists (ACOG) released a policy statement recommending moms and their doctors always plan for a vaginal delivery unless a C-section is medically required. Opting for an elective C-section isn’t a decision you should take lightly — it's one that requires careful consideration and plenty of discussion with your practitioner. So before you raise the topic with your practitioner, ask yourself a few key questions:

Are you afraid of the pain of labor? Most women share your fear (how many people do you know who look forward to pain, after all?), but electing to have a C-section isn't the only way to have a delivery without pain. There are many effective pain-relief options available to women undergoing a vaginal birth.

Have you heard that vaginal birth causes urinary incontinence? While it's true that a vaginal birth can increase the risk of leaking, regular pelvic floor exercises (yup — it's those Kegels again) significantly reduces that risk.

Do you want your delivery to fall on a convenient day? Keep in mind that a C-section is major abdominal surgery. That means that you'll have a longer recovery time and hospital stay (certainly not convenient or especially fun — unless you really enjoy hospital food). And you'll also be exposing yourself to the risks that surgery entails.

Is there another baby in your future? Consider that opting for a C-section now may prevent you from delivering vaginally next time around — although VBACs are generally safe (especially for the 95 percent of women who receive low, horizontal incisions). C-sections also increase your risk for complications including placenta previa and placenta acreta in future pregnancies.

Something else to consider when contemplating a scheduled cesarean that’s not medically necessary: The best time for your baby to make his or her exit from your uterus is when he or she is ready. When an elective C-section is planned, there’s always the possibility that the baby will inadvertently be born too soon.

If you’re still interested in an elective cesarean, talk with your practitioner. Together, you can decide whether it’s the choice that’s right for you and your baby.

What Happens During the Procedure

Whether it's a scheduled surgery or a last-minute decision, the typical cesarean section procedure is straightforward and follows a tightly-scripted game plan. It’s quick, with the procedure itself lasting 10 minutes or less, followed by another 30 minutes to stitch you back up. Most hospitals strive to make a cesarean as much like a normal delivery as possible, with mom awake (but appropriately numb) and dad in the room (watching only if he wants to, of course). Here’s a play-by-play of what you can expect.

Preparation and Anesthesia

The cesarean section procedure begins with a routine IV and anesthesia — usually an epidural or spinal block, so the lower half of your body will be numb but you'll remain awake. Then you'll be prepped by having your abdomen shaved (if necessary) and washed with an antiseptic solution. The operating room staff will insert a catheter into your bladder and place sterile drapes over your tummy. Your birthing coach or partner will be outfitted in sterile garb and allowed to sit near your head and hold your hand.

The emergency room staff will place a short screen blocking your vision of your abdomen, so the field remains sterile and so you don't have to watch yourself getting cut (though if you're a devotee of the Discovery Health channel and this is must-see reality TV for you, you can ask for a mirror to watch). Even if you don't want to see the cut, you will want to catch a glimpse of your baby as he or she emerges, so ask your practitioner to lift your baby up for a quick peek when he or she is delivered.

If you're having an emergency C-section, there might not be time to numb you, in which case (and fortunately this is rarely the case) you'll be completely conked out with general anesthesia for the duration of the cesarean section procedure — which usually lasts no more than a few minutes. When you wake up, expect to feel groggy, disoriented and possibly sick to your stomach. You’ll likely have a sore throat as well from the endotracheal tube that was inserted to prevent any chance of your stomach contents coming back up during surgery and being inhaled or aspirated into your lungs.

Incision and Delivery

Once you're either totally numb or fully asleep, the doctor will make a small incision in your lower abdomen — it may feel like your skin is being unzipped — just above your pubic hair line. With some neat suturing, the scar should be fairly unnoticeable (as long as you don't go for excessively itsy-bitsy bikinis). Your doctor will then make another incision in the lower part of your uterus. For both incisions, two options are possible (and the type made on the skin may not be the same as what’s made on the uterus):

A low-transverse incision. This cut, across the lower part of the uterus, is used in 95 percent of C-sections, because the muscle at the bottom of the uterus is thinner (which results in less bleeding) and is also less likely to split during subsequent vaginal deliveries.

A vertical cut. This incision, down the middle of your uterus, is usually only required if the baby is nestled low in your uterus or in another unusual position.

Next, the amniotic fluid will be suctioned out. Finally your baby will be brought into the world (you might feel a bit of tugging), no worse for the slightly unorthodox trip he or she took into it. Because the excess mucus in his respiratory tract wasn't squeezed out during a journey through the birth canal, some extra suctioning will be necessary to clear those little lungs before you hear that first cry.

Meeting Your Baby

After the cord is cut, the surgeon will remove your placenta and quickly do a routine check of your reproductive organs. Then you’ll be stitched up with absorbable stitches in your uterus (which do not need to be removed) and either stitches or surgical staples on the abdominal incision. It can take 30 minutes or more because each layer of muscle has to be closed. You may receive antibiotics (to minimize your risk of infection) and oxytocin (to control bleeding and help contract the uterus) in your IV. Your blood pressure, pulse, rate of breathing and amount of bleeding will be checked regularly.

You'll then probably have time to get to know the newest person in your life. Some women are able to nurse on the operating table — or, at the very least, in the recovery room. If you're too tired, don't sweat it; you'll have ample time later for bonding (and your baby won't notice the difference). If your baby needs to be whisked away to the NICU nursery, don’t let it get you down. This is standard procedure in many hospitals following a cesarean delivery, and it's more likely to indicate a precaution than a problem with your baby’s condition.

Complications

While C-sections are extremely safe, very rarely complications happen. For mom these can include reactions to medications or anesthesia used during the procedure, blood loss and infection (which is why it’s so important to carefully follow your doctor’s post-op care instructions). Blood clots in the legs, pelvic organs or lungs can occur; while your doctor will take steps to prevent this from happening, it helps to walk after surgery as soon as you’re able. Surrounding organs (like your bowel or bladder) can be injured and require additional surgery to fix. And very rarely, the lining of the uterus becomes inflamed or irritated (called endometritis) — if you notice increasing pelvic pain, unusual discharge or a fever, call your doctor right away.

Babies born by C-section are at a higher risk of transient tachypnea, rapid breathing caused by leftover fluid in the lungs. While the condition sounds frightening, it usually only lasts for a day after delivery and then goes away on its own. If the surgery was performed before week 39 of pregnancy, your baby may be at greater risk of breathing problems if her lungs aren’t fully mature — but your doctor will be keeping a very close eye on her and treating any suspected problems while you’re in the hospital.

Recovery

While you may be eager to start caring for your precious (and needy) newborn, the physical (and emotional) recovery after a C-section takes longer than from a vaginal birth. You can expect to spend around three to four days in the hospital, and it will take at least four to six weeks at home before you’ll feel back to normal. So remember, slow and steady wins this race. And that’s probably exactly what your doctor ordered: to scale back your activity so that you don’t put undue strain on your incision and your energy level. Ignoring that advice will only lead to a longer C-section recovery, so keep these strategies in mind over the next few weeks to cope with the pain and speed recovery:

Lower your expectations. In addition to the soreness you’ll feel at the incision site, you’ll be dealing with virtually the same suite of symptoms during your recovery after a C-section as you would experience in a vaginal delivery: postpartum fatigue (from the operation and sleep deprivation), after pains (as your uterus contracts — you may be given oxytocin to speed the process), postpartum bleeding or discharge (lochia), perineal pain (especially if you tried to deliver vaginally before going into surgery), breast engorgement and (if you thought that wasn’t enough) raging hormones. If you give yourself a realistic time frame to recover, then you’ll be less frustrated as the days turn to weeks (and possibly even months).

Be cautious. Expect your scar to be sore for at least a few weeks, so forgo holding and carrying most things — except the baby. When cuddling or nursing (but not lifting and carrying, yet), place the baby on a pillow over your incision to protect the tender area.

Give yourself a break. Yes, you have a new baby to care for, but remember that you need to take care of yourself too. So take as many shortcuts as you can. Have other people (your partner, your in-laws) bring the baby to you instead of getting up yourself. Don’t waste your energy preparing meals — order in or have your partner heat up a frozen meal. Let the laundry pile up, or send it out to be cleaned. Use paper plates so you don’t have to worry about washing dishes. And of course, let your partner take regular shifts with the baby so you can catch up on z’s. Do whatever it takes to make your life easier — and do it guilt-free.

Keep an eye on your incision. Speed the healing by applying a light dressing to the wound (ask your practitioner how) and wearing loose tops and pants that don’t chafe your belly. Itching and pulling sensations around the incision as well as numbness are all normal sensations that will pass (as will the funky pink and purple colors it turns before fading). If you have a fever, feel a lot of pain (beyond what your practitioner said you would), or the wound gets red or oozy, call your doctor since these could be signs of infection. (A small amount of clear fluid discharge is usually normal, but report it to your physician anyway.)

Take off the pressure. Gas buildup can cause discomfort by causing your intestine to put pressure on the incision, and anesthesia can slow activity in your bowels. So try to avoid it by not consuming foods or drinks that you know make you gassy if possible. And if you do feel gassy, try lying on your left side or back while drawing up your knees, holding your incision site, and taking deep breaths.

Keep regular. Constipation after pregnancy is another symptom to avoid, so try to relax (no pushing when you're on the toilet), eat some fiber-rich foods (whole wheat bread, vegetables and fruits) and drink plenty of fluids. Your doctor may prescribe a stool softener or mild laxative if you need it.

Nourish yourself. Keep healthy snacks and water nearby to maintain your strength and energy. Good picks include nuts, whole-wheat pretzels, string cheese, fiber-rich fruits (fresh and dried) and baby carrots with dip. (Steer clear of constipating foods like bananas, since they won't help if you're a little backed up.)

Get moving (in small steps). You’ll have to wait a few weeks (and until your incision heals) before your practitioner gives workouts the green light. But in the meantime, even when you’re lying down you can speed recovery by boosting your circulation and muscle tone. For starters, regularly flex your feet, stretch your calf muscles, and wiggle your legs around as much as you can. When you feel up to it, stroll around your house slowly (it will help with gas and constipation too). As soon as you feel tired, sit down. Build up your stamina by walking around for as long as you’re comfortable each day and even head outside to walk when you feel ready. Soon enough, you’ll be back on your feet for good.

Do your Kegels. Another exercise you can do right away: Kegels. While you'll have a definite edge when it comes to your "down there" regions, pregnancy still took its toll on those pelvic floor muscles. (You should avoid, however, having sex or putting anything in your vagina for four to six weeks).

Although it’ll be hard to keep from taking charge at home, remember to be kind to yourself and, when you can, relax (for now). In a matter of weeks you’ll be well on your way to full-steam-ahead mommyhood.

The Bottom Line

Even though it's still considered major surgery (be it the happiest kind — since instead of having to lose a gallbladder, you gain a baby), C-sections are usually very safe. In fact, if it's deemed medically necessary, it can be the safest way for your baby to enter the world. (Another bonus, albeit a cosmetic one: your baby will be born with a nicely rounded head, rather than the pointy conehead of a newborn who has made the tight squeeze through the vaginal canal.) It’s also often healthier for you, especially if vaginal delivery is risky. Plus it typically prevents the pelvic wear-and-tear that can result in pain (from tearing or from an episiotomy) — which means sitting will be a lot easier for you than for vaginal deliveries. And another small (but nice) benefit: if the C-section takes place before you've done any (or much) pushing, you'll avoid bloodshot eyes and bruises on your face.

In the end, the best birth is the one that's safest. Any delivery that brings a healthy baby into the world and into your arms is a perfect delivery.

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